Medical Coding and Research Specialist

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential.

JOB SUMMARY: The Medical Coding Specialist is responsible for providing billing analysis of claims and applying coding standards and federal regulations to ensure correct billing practices. In this role, you will perform bill and chart reviews in identifying any variation from quality of billing as well as monitor patient bills for accuracy and compliance.

JOB ROLES AND RESPONSIBILITIES:

1. Review and analyze inpatient, outpatient, and provider billing for medical appropriateness of treatment; analysis of charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type; and any additional information relevant to the negotiation process.
2. Apply recommendation of national coding and regulation standards to claims billed.
3. Prepare clear, concise and legible findings.
4. Research, review and provide internal response based on receipt of itemized bills, claims, operative notes and other documentation as needed.
5. Assist with, create or enhance internal claim and review recommendations.
6. Communicate with co-workers and management regarding clinical and reimbursement findings.
7. Assist with clinical education of staff as it relates to clinical aspects of claims, suggesting additional negotiation talking points or tools, and communicating overall industry or regulatory changes which affect the department.
8. Monitor, research, and summarize trends, coding practices, and regulatory changes.
9. Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed.
10. Collaborate, coordinate, and communicate across disciplines and departments.
11. Ensure compliance with HIPAA regulations and requirements.
12. Demonstrate commitment to the Company's core values.
13. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

Job Scope: This position works independently with general supervision in order to complete the outlined responsibilities. The incumbent balances several projects at a time and work is varied and complex. Complex issues are referred up to higher levels. The incumbent will use established procedures and uses knowledge of the Company's general business principles, industry dynamics, market trends, and specific operational details when performing all aspects of the job.

JOB REQUIREMENTS (Education, Experience, and Training):

• At least 2 years of coding experience.
• Current coder certification (CCS, CCS-P or CPC), or Registered Health Information Technician (RHIA/RHIT).
• Minimum 2 years experience in medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement.
• Knowledge of inpatient/outpatient hospital billing requirement including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-9/10 diagnoses and procedure codes, DRG, APCs.
• Knowledge of professional claim billing requirements including CPT, HCPCS, ICD-10, DRG and REV codes.
• Knowledge of payer reimbursement policies, state and federal regulations, coding convention criteria and applicable industry standards.
• Proficiency using Word and Excel (pivot tables, formulas, etc.)
• Auditing and health information management experience in a healthcare setting preferred.
• Excellent communication (verbal and written), teamwork, training, presentation, negotiation and organizational skills.
• Ability to use hardware, software and peripherals related to job responsibilities, including MS Office Suite and database software.
• Ability to handle multiple tasks in a fast paced environment.
• Ability to read and abstract medical records.
• Knowledge of medical terminology, anatomy, and physiology.
• Ability to interact and discuss audit results with providers.
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended perio